Objective To assess the impact of epidemics and pandemics on the utilisation of paediatric
emergency care services to provide health policy advice.Setting Systematic review.Design
Searches were conducted of Medline, EMBASE, CINAHL, Scopus, Web of Science and the
Cochrane Library for studies that reported on changes in paediatric emergency care
utilisation during epidemics (as defined by the WHO).Patients Children under 18 years.Interventions
National Institutes of Health quality assessment tool for observational cohort and
cross-sectional studies was used.Main outcome measures Changes in paediatric emergency
care utilisation.Results 131 articles were included within this review, 80% of which
assessed the impact of COVID-19. Studies analysing COVID-19, SARS, Middle East respiratory
syndrome (MERS) and Ebola found a reduction in paediatric emergency department (PED)
visits, whereas studies reporting on H1N1, chikungunya virus and Escherichia coli
outbreaks found an increase in PED visits. For COVID-19, there was a reduction of
63.86% (95% CI 60.40% to 67.31%) with a range of −16.5% to −89.4%. Synthesis of results
suggests that the fear of the epidemic disease, from either contracting it or its
potential adverse clinical outcomes, resulted in reductions and increases in PED utilisation,
respectively.Conclusions The scale and direction of effect of PED use depend on both
the epidemic disease, the public health measures enforced and how these influence
decision-making. Policy makers must be aware how fear of virus among the general public
may influence their response to public health advice. There is large inequity in reporting
of epidemic impact on PED use which needs to be addressed.Trial registration number
CRD42021242808.All data relevant to the study are included in the article or uploaded
as supplementary information.
